Healthcare Provider Details

I. General information

NPI: 1336560747
Provider Name (Legal Business Name): MIND MATTERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BIG TREES RD, SUITE D
MURPHYS CA
95247
US

IV. Provider business mailing address

150 BIG TREES RD, SUITE D
MURPHYS CA
95247
US

V. Phone/Fax

Practice location:
  • Phone: 209-728-2184
  • Fax: 209-728-2185
Mailing address:
  • Phone: 209-728-2184
  • Fax: 209-728-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRISTI CANEPA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 209-728-2184